1870 Seminole Rd PLRS21-0074 2 Fixtures S�SLAN ix, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
- PLRS21-0074
CITY OF ATLANTIC BEACH
ISSUED: 5/3/2021
800 SEMINOLE ROAD
010'' ATLANTIC BEACH. FL 32233 EXPIRES: 10/30/2021
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2 Fixtures: REMOVE LOAD
1870 SEMINOLE RD PLUMBING RESIDENTIAL BEARING WALL & $2000.00
RECONFIGURE KITCHEN
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0520 SELVA MARINA UNIT 09
COMPANY: ADDRESS: CITY: STATE: ZIP:
DREW HARTMANN 4331 CEDAR RD ORANGE PARK FL 32065
PLUMBING, INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
CHRISMAN STACEY 1870 SEMINOLE RD ATLANTIC BEACH FL 32233-5916
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 2 $14.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date:5/3/2021 1 of 2
%'S`1ITi, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
S SA
r r CITY OF ATLANTIC BEACH PLRS21-0074
~~ 800 SEMINOLE ROAD ISSUED: 5/3/2021
'-'...1.-5,-,119.;,,V ATLANTIC BEACH. FL 32233 EXPIRES: 10/30/2021
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$73.00
Issued Date:5/3/2021 2 of 2
PlumbingPermit Application l **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 PLRS G j - 00 T 21
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: ChaaI /11iA-1\)/fl (' ['-"G/ 1Y PROJECT VALUE $ .e )°'
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures L��fh
Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.**
❑ Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances
governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions
of any other state or local law regulation construction or th performance of construction.
AOwner Name: e deb Phone Number: ri -
Plumbing Company:Q ed /41.)--0/#4-4-1J 1' 0444le Phone: e '6 Fax 2 /./ 1
�5'( CC� N (� d Vi1 �/9nL PL Zi 20.6
Co. Address: City: State. p:
I C
License Holder: tW ecvrll IL k U r l State Certificati•n/Registration # C F c l VZ r�' 7/
Notarized Signature of License Holder / V �✓�
The foregoing instrument was acknowledged me th'f "'1 d of mill , 20,2_I , in the State of Florida,
County of D U V A 1,
w �
Signature of Notary Public ///`. A
CHRISTIAN GILES
Lk MY COMMISSION[1 HH117153
25
N [ ] Personally Known OR [> oduced Identificationy
EXPIR5S:April 13,2025 Type ��
fOF,F�OP'' BondedThNotaryPub4cUnderwriters T e of Identification: L
Updated 10/17/18